HomeMy WebLinkAboutTitle V Inspection Report - 1504 SALEM STREET 7/19/2018 -
4
Cornmotivvoalth ,1>f Massachusetts
10itle :)Official Inspec;tvon Fora
Subsurface Sewage Disposal System Form - Jot for Voluntary Assessments , 41 �OWN OF` I y RTMEN "i.P
Y
_._ .._,___.... f--q, - L
ro CS
AddrH
P . _.- _....—.. .._...— ._,..__
Owner
information is
required for every U'-`A�m
_ PIpage. tTownState Zip Coda Date
bte of Inspection
f �j)
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form,
Important:When
tilling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your TT]r
cursor-do not Charles J. Roux
use the return —
key, Name of Inspector Charles
J. Roux 1_�LC;
a_
Company Name
_ 213 Patten Road.
C:ompany 1dress
Tewksbur
876
city1rown __ ...
978-640-9984 4tate 51891 Zip
Telephone Number -"
ic;enso Number
ertl ICc�tlon
I certify that I have personally inspected the sewage disposal,system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DiP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15,000). The system:
Passes C1 Conditionally Passes Cel Fails
Needs Further Evaluation by the Local Approving Authority
I epo,ors Signature
Gate __..... __.
The systern inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days,of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP, The original should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority,
""This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
tbinsx<oc•rev.wir,
Title 5 Official Inspection Form:Subsurface Sewage Olsposet System.page I or 17
commonwealth ofMassachusetts
-tion Form
ir"tNe wOfficial 0nse
Subsurface Sewage Disposal Stem Form Not for Voluntary Assessments
r�Address
Owner Owner's Name ----------�--------'�--
information is
required for every ___-
_-
vmuo, cxw,w°n State -- Zip 7oJe-- ---��—'
B. Certification (cont.) ----------------- ------------
Inspection Summary: Check A,B.C.D or E/always complete all of Section D
AJ System Passes:
I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 orin318CMR 15,304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
13) System SymtmnnConditionally Passes:
[l Dnenrmoreayatemommponentoaodmooribadindhe ^Cund|Uonm| Pouu",sectionnoodtobe
replaced or."p"nou The system, upon completion cvthe | by
the Board of Health, will pass. /11,
Check the box for"yes", .,no"or"riot determined" (Y, N, ND)for following statements, If"not
determined," please explain.
The septic tank = metal and over/oyears old*prthe oo tank (whether metal orriot)|ostructurally
unsound, exhibits substantial infiltration cvexnmano nkfailure }aimminent. System will pass
inspection ifthe existing tank ioreplaced with a comPlying septic tank uoapproved bythe Board of
Health. /
/
°
Amubu| septic tank will pass inspection ifitka'structurally sound, riot leaking and UuCertificate of
Compliance indicating that the tank|uless than 2Oyears old ioavailable,
'
El Y 0 N �l ND (Explain be|ww):
151ns.doc-rev,6/16 Tit1r)5 Official Inspection Form:Subsufface Sewage 1)jsposal syslerT,-Page 2 of 17
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/
commonwealth of Massachusetts
Y Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
f'raperty Addrass
Owner Ow- --
ner's
information is
required for every
page. CltyCtown —._ _
State 71r1 Cc1dt1 U Ito of n Inspertia ..
El Bump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
U Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipo(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced U Y ❑ D (Explain below):
Ll obstruction is removed ❑ Y II/El D (Explain below):
❑ distribution box is leveled or replaced ❑ / N El ND (Explain below):
The system required pumpinc xiiore than 4 times a year due to broken or obstructed pipe(s). The
System will pass inspections (with approval of the Board of Health):
El broken pipe(s) • e replaced ❑ Y ❑ N ❑ ND (Explain below):
obstrurtior,�fs removed ❑ Y El N ND (Explain be
� ❑ ( p ,low):
0
174
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safy or the environment.
l 1. System will pass unless Board of Hea fi determines in accordance with 310 CMR
15.303(1)(b)that the system Is not funr�tlning in a manner which will protect public health,
safety and the environment:
A
[� Cesspool or privy is withirx,Q feet of a surface water
❑ Cesspool or privy is Within 50 feet of a bordering vegetated wetland or a salt marsh
151ns,doc•rev,e5115
Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Faye 3 of 17
Commonwealth of Massachusetts
=r r Title 5 Official Inspection Form
Subsurface Sewaa Disposal System Farm Not for Voluntary Assessments
Omer
Information is
required for every
page.
ity/TDwn 'sate LitF Code [date of Inspertian __.
B. Celrtification (cant.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
0 The system has a septic tank and sail absorption system (SAS)and tlae SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
U The system has a septic tank and SAS and the SAS is win a Zone 1 of a public water
supply, ,�'
0 The system has a septic tank and SAS and the SA is within 50 feet of a private water
supply well.
[M) The system has a septic,tank and SAS and the SS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance: �
**This system passes if the well watera C lysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and,t e: presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that r�o other failure criteria are triggered. A copy of the analysis mur,t
be attached to this form.
3. Other:
�F
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"too" to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
L] Discharge}or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or-.logged SAS or cesspool
X Static liquid level in I'he distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
f5ins.doc rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal Systern-Page 4 of 17
scCommonwealth of Massachlasetts
=; Title 5 OM
Pial Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M`-v
/s
Property Address
Owner ow__.__.._..—______,_.._,.
ner's Name
information is
required for every
page. City/Town _. __.
State Zip Code Date of Inspection _.
B. Certification (stmt.)
Yes No
r- Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:._.
E] U Any portion of the SAS, cesspool or privy is below high ground water elevation.
E3 p Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
0_ D Any portion of a cesspool or privy is within a Zone 1 of a public well.
E-) [2' Any portion of a cesspool or privy is within 50 feet of a private water supply well.
rf Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis, [This
system passes if the well wager analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonla nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
12" The system is a cesspool serving a facility with a design flow of 2000gpd•.
10,000gpd.
Ej The system fails. I have; determined that one or more of the above failure
criteria exist as described in 310 CMR 15.3073, therefore the systern fails. The
systern owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
the system is within 40 feet of a surface drinking water supply
11 El the systern is with)d200 feet of a tributary to a surface drinking water supply
El 0 the system is I sated in a nitrogen sensitive area (Interim Wellhead Protection
Area-- IW
P }or a mapped Zone II of a public water supply well
i �
If you have answered "yes"tof;"ny question in Section E the system is considered a significant threat,
or answered "yes" in Sectio) D above the large system has failed. The owner or operator of any larcge=
system considered a signf'#cant threat under Section E or failed under Section D shall upgrade the
system in accordance v1kh 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
1.51ns.doe rev.6116 Title 5 Offfclal Inspectlan Donn:SUbstldace Sewage[>isposal System•page 5ol 17
Gornmmo0VVealth of Massachusetts
Title 5
_ _'- -- -_~p~~ct°omx Form
Subsurface sewage Disposal System Form -Not for Voluntary Assessments
. ' --------
Owner �
Information is ----N-~~ ���------��----
required for every
page. City/Town ]���---
��--'----------------____ p Code ~~^~- ^'~r^~`'`''
C. Checklist
--- —'-----
Check ifthe following have been done. You must indicate ^yao^ or"no~amhaeach ofthe following:
Yea No
3 11 Pumping |nformeUonwas provided bythe owner, occupant, orBoard ofHealth
[7-1[
Fl
�� �� Were any ofthe system componentspumped out inthe previous two weeks?
Fl Has thesymtomreceived normal flows inthe previous two week period?
Have |e/govo|umenofwahurbeonintvoduxed \otheuyotemneoant|yoraapadof
-- ��
this inspection?
-^/ �l VVereanbuUtplans ufthe system obtained and examined? (If they vveranot
-- ^~ available note as N/A)
E] Was the facility ordwelling inspected for signs ofsewage back Lip?
r-K' Fl
Was the site inspon\edfor signs u(break out?
Were all system oumponento, excluding the SAS, located onsite?
n/
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition v/the baffles urtees, material ofconstruction,
dimensions, depth ofliquid, depth mf sludge and depth nfsoum?
Was the facility own6,,!r(and occupants if different from owner) provided with
~� `^
information on the proper maintenance Of Subsurface sewage disposal qystems?
The size and location sfthe Soil Absorption System (SAS)onthe aituhas
been determined based on:
Existing information. For example, e plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Part C is at issue
~~ ^~
approximation ofdistance |aunacceptable) [31OCMR 15.302(5)]
D. System Information
Residential
--------- ---------------------------�-
0esidantia| F|owCond|bune:
Number ufbedrooms (design): ----�---- Number of bedrooms (actual): ---'/----
DESIGN flow based on91OGK8R15.2D3 (for example: 11Ugpdx#cfbedvooms):
�
*�doc'rev.m* Title 5 Official Inspectlon Form:Subsurface sewage IMPOSOI System-flags 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form Not for Voluntary assessments
Property address .—
owner -owwnerner''ss Name
infonnation is
required for every
page. CityfTowrl .-_ . ofIns __. .._._,_...
State lip Cada gate of Inspection
D. System Information
Description:
Number of current residents:
Does residence have a garbage grinder? El Yes I_I No
Is laundry on a separate sewage system? (Include laundry system Inspection
information in this report.) ❑ Yes 1_, No
Laundry system inspected? ' [ q� Yes (_J No
Seasonal use? ❑ Yes �, No
Water meter readings, if available(last 2 years usage (gpd)):
Detail:
Sump purnp? Fl Yes [ ] No
Last date of occupancy:
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CIVIR 15203):
Galions per day(qpd)
Basis of design flow (seats/persons/sq.ft., e �:
Grease trap present? Yes
El El No
Industrial waste holding tank present' [m„] Yes (._) No
Non-sanitary waste discharged to he Title 5 system? n Yes r ) No
Water meter readings, if avai dole:
fEilns.dac•rev.IV16 Titte 5 Official Inspecttan Form:Subsurface sewage Disposal Systema-page 7 of 17
Commonwealth of Massachusetts
Title ~ Official
"Unspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
pr*pnoy�ddrvsu
v=nn, �=nem � _-
mmnmvtionio --
required for every
P*ov. C^y^n,^______ 7State -- ������--- ------�'--
D. System UKUf«�r0���t~��U� /cOOL\ ----- '--------
Last date ofououpancy/unp: Date
------'--
Other (describe be]ow):
'--
General Information
Pumping Records:
8ouroemfinformaUon: —
Was system pumped aapart ofthe inspection? Yee D'I 'o
|fYes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumpinO: —
----'–
TypemfSyatemn:
Cq Septic tank, distribution box, soil absorption system
D Single cesspool
[l
Overflow cesspool
/
[l Privy
LJ
Shared system (yes or no) (if yes, attach previous inspection records, if any)
[l
Innovative/Alternative technology, Attach a copy of the current operation and
maintenance contract(to boobtained from system owner)and ocopy oflatest:
inspection ofthe |A\system bysystem operator under contract
Fl
"Fight tank. Attach acupyo[the DEP approval.
[l Other(describe):
mm".o='mv.mm
Commonwealth of Massachli,J!Seft
Title 5 OfficiaU Ins������t~���� Form
Subsu�ace Sewall: Dhy | Svs -
Voluntary Assessments
. ort
per' Ad�d_.
vwnm O� —
Information is
--�-- -
required for every --------
page. wxw/vwn State -'
D. System Information (cont.)
Approximate age ofall components, date inmtaU
if known) nd source of information:
7 ' -
Were sewage odors detected when arriving atthe site? [l Yau NO
Building Sewer(locate on site plan):
Depth below grade: feet
----
Material ufconstruction:
@
cast iron 48 PVC [j other(explain):
Distance from private water supply well orsuction line: -_
Comments (on condition wfjoints, venting, evidence ofleakage, o1o.):
Septic Tank (locate on site plan): Z11/ :5 Y"
� ~~,~' ~~'~~ o'~°": --��
�
Material ofconstruction:
� concrete � metal fiberglass � polyethylene Flother(exp|u|n)
If tank iSmetal, list age:
years
|oage confirmed byaCertificate ufCompliance? (attach a copy of certificate) Yes NO
Dimensions: '~
Sludge depth:
mins.doc'"°6116 1 Itin 5 Official Inspection Form:Subsullaco Sowage DiSposal System-Palle 9 of 17
Gor7rrmoriwealth of Massachusetts
s T'i e 5 Official Inspection Form
Subsurface Sewage Disposa System Form -Not for Voluntary Assessments
lis
raperty Address _._...._ __...___..._.._.-
Owner .._.s.Nam__.e__
wner'
information is
required for overt' __ _...—
--
page, CityfrownuflmtO Lip Code Uate of Inspection
. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom Of Outlet tee or baffle
Scum thickness
Distance from top of scum to top Of Outlet tee or baffle --- .---.-_---
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? � 4- '. :. f^ "
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
C
�;
Grease Trap (locate on site plan):
Depth below grade:
� feef
Material of construction:
LI concrete Cl metal [ I fib f lass pol eth lene
y y other(explain j;
Dimensions: _..... _...__.
Scum thickness
Distance from top of scum tortQp of outlet tee or baffle
Distance from bottom of,cum to bottom of outlet tee or baffle
r
Date of last pumping: __._----._.__`___—.__...___._......-__ _
[safe
151ns.doc rev.6116 Title 5 Official Inspeclion Few Subsurface Sewage Disposal Syslem-Fags 10 of 17
Commonwealth of Massachusetts
Title 5 ►ffi�-ial Inspection Form
a
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
)
Property Address
Owner Owner's Name
Information is
required for every -------
page.
_ ._page, City/Town—� state Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
....... _ ------
Tight or Holding Tank (tank must be pr.lmla/at tirne of inspection) (locate on site plan):
Depth below grade:
Material of construction:
l
❑ concrete d1 metal [ ) fibergla ❑ polyethylene ❑ other (explain):
Dimensions:
__.. _... _.__.._.,.... _ .-
— _
Capacity: "` gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
i
Alarm level: --- Alarm in working order: ❑ Yes E] No
Date of last pumping: Date
Comments (conditiq of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). is copy attached? El Yes No
lBlns.doc rev.61 t6 Title 5 Official Inspectbn form:Subsurface Sewage Disposal System-Pago 11 of 17
Commonwealth of Massachusetts
'Title 5 Official Inspection Form
,qm Subsurface Sewage Disposal System For
-„ p y m Not for Voluntary Assessments
ropertyAd ress
Owner —
CJwner's
information is
required for every _.
page. Glty/1«wn � -_,_,_� _ _—.....___
State L1 Code -.
�_.__..___.— p gate<rf Inspection
). System Information (cont.)
Ja �.
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid I vel above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber (locate on site plan):
Pumps in working order: [] Yes El No*
Alarms in working order: El Yes [] No*
Comments (note;condition of pump Chamber, con 'tIG n of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass,
Soil Absorption System (SAS) (locate on site plan, excavation not required):.
If SAS not located, explain why:
15111S.doo rev.6116 "1111e 5 C141iclal Inspection form:Subsurface Sewage msposai system•page 12 cif 17
Commonwealth of Massachusetts
My# N T���.I � f1lClal lInpectidn FOq"f1
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
71i
a 'Property Address .
Owner - __-____ _..—.---
dwner`s blame
information is
required for every
page. CityfT own S
. �i<1te Zip Code Gate of Inspection
D. w3ystem Information (cant.)
'Type:
.� leaching pits number:
leaching charnbers number: -..—_.-..
0 loaching galleries number;
[�
leaching trenches number, length:
[.� leaching fields number, dimensions:
[..a overflow cesspool number:
innovative/alternative system
Type/name of technology: -_,___----
Comments (note;condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):'
Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
�
P p
Depth---to of liquid to inlet invert
i
Depth of solids layer
Depth of scum lager
Dimensions of cesspool , _.....__, . _ ._... ._..... ----_._...,
Materials of construction ,
Indication of groundwater in bw Yes .1 Na
Mns.doc•rov.6116
Tilla 5 Official tn;;pprllon Fonn,Sursurraca Sowaga IJlsposal Sysrpm•r'ayn 11�t 17
SubsurfaceCommonwealth of Massachusetts
Title 5 Offic-oial Inspection Form
. —,—,A~~~~
owner
mmmamm� -- '-- ��-----�--
required for every
»aoe. City/Town state-- �"1-pTodo--'
D. System Information (cont.)
Comments
condition ofvogotmhonetc.):
'
Privy(locate on site plan):
Materials ofconstruction: -------
Dimensions
Depth of solids
Comments (note condition of soil, signs of hyo/aulicfailture, level of ponding, condition of vegetation.
|
'
mins-doc'rev,6110 ngo 5 official Inspecoon Form SubsuTface Sewage Disposal Syslool-pjge 14 of 17
Commonwealth of Massachusetts
Tau T'Ale 5 Official Inspection Form
Subsurface Sewa a pis osal System P rm �Nat
- - Y for Voluntary Assessments
Property Address
Owner
Owncsr's hJafne
information is
required for every
page. Cityfl own — — —
State lip Code Daie of InSperiion _
D. System Information (cant.) _ __...._
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landm,_irks or benchmarks. Locate all wells within 100 feet, Locate
where public water Supply enters the building. Check one of the boxes below:
hand-sketch in the area below
(� drawing attached separately
f
i
r
i
i
G�
y Fs
G
r
i
151ns.doc rev.6116
Title 5 Official Inspection Form;Subsurface Sewage Disposal System Page 15 of 17
commonwealth of Massachusetts
Title 5 Official In,143plection Form
Subsurface Sew ge Disposal Systern Form -Not for Voluntary Assessments
Property Address
Owner —--–-------
Owner's Name
information is
required for every
page. City/Town State Zip Code Dato of Inspection
D. System Information (cont.)
Site Exam:
Check Slope
El Surface water
J-] Check collar
F-1 Shallow wells
L-Estimated depth to high ground water:
feet
Please indicate all methods used to determine the high ground water elevation:
Obtained from system design plans on record
If checked, date of design plan reviewed:
Date
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board Of Health-explain:
Checked with local excavators, installers-(attach documentation)
El Accessed USGS database- explain:
You must describe how you established the high ground water elevation:
------ ---------
Before filing this Inspection Report, Please see Report Completeness Checklist on next page.
t5ins.cloc-rev.6/16
Title 5 Official Inspection Form:Subsurface Sewage Disposal System.pada 16 of I'7
Commonwealth of Massachusetts
Title 5 Official Inspection ection Form
Subsurface Sewage Disposal stern Form
Not fo
- - Y r Voluntary Assessments
w
Property/(CCPSS���
-
Owner _._ ..__—. _ —...._. ._.._.__—_,_.......—
Owri
information is
required for every
page, City[lown
_ _ .
State Zip Code U�te�of InSpE E,tion
E. Report Completeness Checklist
C. Kinspection Summary: A, t3, C, D, or Ew checked
v Inspection Summary D (System f=ailure Criteria Applicable to All Systerns)completed
P"System Information -- Estimated depth to high groundwater
sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
I
I
Wfns.doc-rev.6/16
Title 5 Official Inspection Form:Subsurface Sewage E}Isposal Syslom•Page 17 of 17
D
4,0
0
Town of North Andover
HEALTH DEPARTMENT
AOWS
CHECK# `3 DATE:
: 3 o
l
LOCATION: el
H/O NAME: e,
/
CONTRACTOR NAME: -An�LA,
Type of Permit or License: (Check box)
.
0 Animal $
• Body Art Establishment $---
• Roily Art Practitioner $
El Dumpster $
0 Food Service- $
0 Funeral Directors $
• Massage Establishment $
• Massage Practice
• Offal(Septic)Hauler
• Recreational Camp $
• Sun tanning
• Swimming Pool
• Tobacco
• Trash/Solid Waste Hauler $
• Well Construction
SEPTIC Systems:
* Septic-Soil Testing $
* Septic-Design Approval $
* Septic Disposal Works Construction(DW0 $-
0 Septic Disposal Works Installers(DWI) $
0 Title 5 Inspector $
Title 5 Report
0 Other. $
Health-Agent Initials
White-Applicant Yellow-Health Pink-Treasurer